Canada - World Health Organization Regional Office for Europe
Canada - World Health Organization Regional Office for Europe
Canada - World Health Organization Regional Office for Europe
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76<br />
<strong>Health</strong> systems in transition <strong>Canada</strong><br />
The majority of PHI comes in the <strong>for</strong>m of employment-based group policies<br />
that are benefit plans sponsored by employers, unions, professional associations<br />
and similar organizations (Hurley & Guindon, 2008). Since this type of<br />
insurance “comes with the job”, it is not “voluntary”. Canadians receiving or<br />
purchasing PHI are exempt from taxation on these benefits or premiums by the<br />
federal government and all provincial governments except Quebec.<br />
Almost all PHI in <strong>Canada</strong> would be classified as complementary to medicare<br />
(Hurley & Guindon, 2008). PHI that attempts to provide a private alternative to<br />
medicare (substitutive PHI) or faster access to medicare services (supplementary<br />
PHI) is prohibited or discouraged by a complex array of provincial laws and<br />
regulations. Six provinces – British Columbia, Alberta, Manitoba, Ontario,<br />
Quebec and Prince Edward Island – and three territories prohibit the purchase<br />
of PHI <strong>for</strong> medicare services. In the remaining four provinces, the purchase of<br />
PHI <strong>for</strong> such services is discouraged through various means, in particular by<br />
not allowing physicians to work in both public and private systems at the same<br />
time (Flood & Archibald, 2001; Marchildon, 2005).<br />
Until recently, PHI has received relatively limited policy attention because<br />
it has been restricted to complementary insurance – covering those services not<br />
included in medicare (Hurley & Guindon, 2008). In the wake of a 2005 ruling<br />
by the Supreme Court of <strong>Canada</strong> that Quebec’s law prohibiting supplementary<br />
insurance <strong>for</strong> medicare services violated Quebec’s Charter of Rights in the<br />
presence of excessive waiting times <strong>for</strong> non-emergency surgery, there have<br />
been repeated calls by market advocates <strong>for</strong> PHI <strong>for</strong> medicare (Flood, Roach<br />
& Sossin, 2005; Flood, 2007).<br />
3.6 Social insurance<br />
Of the remaining sources of finance, the single most significant is social<br />
insurance funding from provincial workers’ compensation schemes. <strong>Health</strong><br />
benefits <strong>for</strong> work-related injuries and sickness under provincial workers’<br />
compensation plans pre-date the introduction of medicare, with the first such<br />
scheme introduced by British Columbia in 1917. Administered by provincial<br />
WCBs, these benefits are paid <strong>for</strong> by compulsory employer contributions that<br />
are set by provincial law. WCB payments <strong>for</strong> health services were estimated to<br />
be C$1.4 billion, roughly 1.5% of public health expenditures (Marchildon, 2008).<br />
Much of this is paid directly to provincial health authorities and individual<br />
health facilities and providers.